Provider Demographics
NPI:1598868093
Name:MED PED CLINIC OF WICHITA PA
Entity Type:Organization
Organization Name:MED PED CLINIC OF WICHITA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHZAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-691-0309
Mailing Address - Street 1:9415 E HARRY ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5089
Mailing Address - Country:US
Mailing Address - Phone:316-691-0309
Mailing Address - Fax:316-691-0881
Practice Address - Street 1:9415 E HARRY ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5089
Practice Address - Country:US
Practice Address - Phone:316-691-0309
Practice Address - Fax:316-691-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0429468207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100410020HMedicaid
KS102785Medicare ID - Type Unspecified